# Contains Nonbinding Recommendations

Draft Application Forms

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United States

Environmental Protection Agency Office of Water

Washington, D.C. EPA Form 3510-2D

Revised <INSERT DATE>



# Water Permits Division 

# Application Form 2D

New Dischargers - Wastewater

Discharge Information

NPDES Permitting Program

NPDES Proposed Application Forms for Public Docket ID No. EPA-HQ-OW-2016-

0145 & Docket ID No. EPA-HQ-OW-2016-0146.

This document is being distributed fo r comment purposes only. Comments and

suggestions regarding this draft document should be submitted through electronic

comments to http://www.regulations.gov.

Note: Complete this form and Form 1 if your facility is a new manufacturing, commercial, mining, or

silvicultural facility that has yet to commence discharge of process wastewater.

# Contains Nonbinding Recommendations

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# Paperwork Reduction Act Notice

The U.S. Environmental Protection Agency estimate s the average burden to complete Form 2D to

average 32 hours for some minor facilities and 46 hour s for some major facilities, with a weighted

average for major and minor faci lities of 33.2 hours per response. This estimate includes time for

reviewing instructions, s earching existing data sour ces, gathering and maintaining the needed data, and

completing and reviewing the collection of inform ation. Send comments regarding the burden estimate

or any other aspect of this collect ion of information to the Chief, Information Policy Branch (PM-223),

U.S. Environmental Protection Agency, 1200 Penns ylvania Avenue, NW, Washington, DC 20460 and to

the Office of Information and Regulatory Affa irs, Office of Management and Budget, 725 17 th 

# Street,

NW, Washington, DC 20503, marked “Attention: Desk Officer for EPA.”

# 2D-1 

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FORM 2D—INSTRUCTIONS

General Instructions

Who Must Complete Form 2D?

Applicants who answered “yes” to Item 1.2.5 on Form 1 must

complete Form 2D. This means that your facility is a new

manufacturing, commercial, mining, or silvicultural facility that has

yet to commence discharge of process wastewater.

Where to File Your Completed Forms?

Submit your completed application package (Forms 1 and 2D) to

your National Pollutant Discharge Elimination System (NPDES)

permitting authority. Consult Exhibit 1

– 1 of the “General

Instructions” of Form 1 to determine your NPDES permitting

authority.

Public Availability of Submitted Information

EPA will make information provided on the various NPDES permit

application forms available to the public for inspection and copying

upon request. No information on Form 2D (or related attachments)

may be claimed as confidential.

You may make a claim of confidentiality for any information that you

submit to EPA that goes beyond the information required by Form

2D. Note that NPDES permitting authorities will deny claims for

treating any effluent data (estimated or actual) as confidential. If

you do not assert a claim of confidentiality at the time you submit

your information to the NPDES permitting authority, EPA may make

the information available to the public without further notice to you.

EPA will handle claims of confidentiality in accordance with the

Agency’s business confidentiality regulations at Part 2 of Title 40 of

the Code of Federal Regulations (CFR).

Completion of Forms

Print or type in the specified areas only. If you do not have enough

space on the form to answer a question, you may continue on

additional sheets, as necessary, usi ng a format consistent with the

form.

Provide your EPA Identification Nu mber from the Federal Registry

Service and facility name at the top of each page of Form 2D and

any attachments. If you do not know your EPA Identification

Number, contact your NPDES permitting authority. See Exhibit 1

– 1

of the “General Instructions” of Form 1 for contact information.

Additionally, for Tables A through E, provide the applicable Outfall

Number at the top of each page.

Do not leave any response areas blank unless the form directs you

to skip the item. If the form directs you to respond to an item that

does not apply to your facility or activity, enter “NA” for “not

applicable” to show that you considered the item and determined a

response was not necessary for your facility.

The NPDES permitting authority w ill consider your application

complete when it and any supplementary material are received and

completed according to the authority’s satisfaction. The NPDES

permitting authority will judge the completeness of any application

independently of the status of any other permit application or permit

for the same facility or activity. Follow-up Requirements

Form 2D requires that you submit estimated data regarding your

effluent. Note that no later than 18 months after you begin

discharging from the proposed facility, you must complete and

submit Section 7 of NPDES Application Form 2C. However, you

need not complete those portions of Section 7 that require tests you

have already performed under the discharge monitoring

requirements of your NPDES permit. In addition, your NPDES

permitting authority may waive the requirements of Form 2C,

Section 7 if you make the demonstrations required under 40 CFR

122.22(g)(7)(i)(B) and 122.21(g)(9).

Definitions

Definitions of all significant terms used in Form 2D are in the

“Glossary,” which follows the “General Instructions” in Form 1.

Line-By-Line Instructions

Section 1. Expected Outfall Location

Item 1.1. Identify each of the facility’s outfall structures by number.

For each outfall, specify the latitude and longitude, method of

collection, and name of the receiving water. The application form

provides reporting space for three outfalls. If your facility has more

than this number, attach additional sheets as necessary. The

location of each outfall (i.e., where the coordinates are collected)

shall be the point where the discharge is released into a water of

the United States. In the column marked “Collection Method

Information,” indicate the following: (a) horizontal collection method,

which is the type of method/device used to identify the coordinates

(e.g., global positioning system or GPS device, census block

centroid, an address, State Plane Coordinate System or SPCS,

etc.); (b) scale of your source map or photo if applicable (e.g., the

proportional distance on the ground for one unit of measure

typically expressed in ratio form such as 1:24,000); and

(c) horizontal reference datum (i.e., the coordinate reference

system) to which your coordinates relate.

GPS devices are commonly used to electronically record the

latitude and longitude coordinates of a property. It is also possible

to use geographic information systems (e.g., ArcView), online

sources (e.g., U.S. Geological Survey or USGS) to identify

coordinates. The online services r equire that you enter a property

address, the nearest intersection, or zip code. The system then

generates the coordinates. The horizontal collection method for

such sources is “Interpolation–Satellite.” You would not report a

source map scale if you used a GPS device or one of the online

systems. For the horizontal reference datum, you would report one

of the following three options:

1. North American Datum of 1927 (NAD27): This datum was based

on the ground survey in Europe and North America in the 19 th



# century. NAD27 was the standard for many years because the

USGS published its topographic maps in this datum. If you are

reporting a location using a USGS 7.5-minute map, NAD27 is

your default datum.

2. North American Datum of 1983 (NAD83): NAD83 updated

NAD27 with current measurements using radio astronomy and

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FORM 2D—INSTRUCTIONS CONTINUED

satellite observations. When the USGS began publishing digital

data, the NAD83 was used which provided a more accurate

representation of the earth’s shape and a more accurate

depiction of the location of objects on the earth.

3. World Geodetic System of 1984 (WGS84): This datum was

developed from the measurements calculated in NAD83. If you

used a GPS to calculate your latitude/longitude coordinates,

WGS84 is the default datum.

If you need further guidance in responding to Item 1.1, refer to

http://www.epa.gov/geospatial/latitudelongitude-data-standard

.

Section 2. Expected Discharge Date

Item 2.1. Report the expected date the facility will commence

discharging (month, day, and year).

Section 3. Average Flows and Treatment

Item 3.1. For each outfall, report the operations expected to

contribute wastewater to the effluent and an estimated average flow

from each. Briefly describe the planned wastewater treatment for

each operation or list the applicable treatment code(s) from Exhibit

2D-1, located at the end of these Instructions. Finally, for each

operation, note the ultimate disposal of any solid or liquid wastes

not expected to be discharged.

Section 4. Line Drawing

Item 4.1. Attach a line drawing depicting the expected water flow

through your facility, from intake to discharge. Indicate the sources

of intake water (e.g., city, well, stream, other); all sources of

wastewater contributing to the effluent, including process and

production areas, sanitary flows, cooling water, and stormwater

runoff; and labeled treatment units. You may group similar

operations into a single unit.

Construct a water balance on the line drawing by showing average

flows (specify units) between intakes, operations, treatment units,

and outfalls. Show all significant losses of water to products, the

atmosphere, and discharge. You should use actual measurements

wherever available; otherwise us e your best estimate. If you are

unable to determine a water balance fo r your activities (such as

mining activities), provide a pict orial description of the nature and

amount of any sources of water and any collection and treatment

measures. An example of an acceptable line drawing is provided in

Exhibit 2D–2 at the end of these Instructions.

Section 5. Intermittent or Seasonal Flows

Item 5.1. Specify whether any of the expected discharges

described in Sections 1 and 3 will be intermittent or seasonal. If

“yes,” continue to Item 5.2. If “no,” skip to Section 6.

Item 5.2. List applicable outfalls that will have intermittent or

seasonal flows. For each, indicate the operations that will contribute

to the flow. For each operation, indicate the average days per week

and average months per year the discharge will occur, the

maximum daily flow rate, maximum total volume, and the duration

of the discharge in days. The estimated flow rate and volume

should not include stormwater runoff, spillage, or leaks. A discharge

is intermittent if it occurs with interruptions during the operating hours of the facility. Discharges caused by routine

maintenance shutdowns, process changes, or other similar

activities are not considered to be intermittent. A discharge is

seasonal if it occurs only during certain parts of the year. The

frequency is the average recurrence rate of the discharge (in days

per week and months per year). The duration is the average value

of the time duration during which the discharge occurs (in days).

The maximum daily flow rate is the highest daily value and should

be reported in million gallons per day (mgd). Maximum total volume

means the total volume of any one discharge within 24 hours and is

measured in units such as gallons.

Section 6. Production

Applicable ELGs

Item 6.1. Indicate whether any effluent limitation guidelines (ELGs)

promulgated under Section 304 of the Clean Water Act (CWA)

apply to your facility. All ELGs promulgated by EPA appear in the

Federal Register and are published annually in 40 CFR

Subchapter N. An ELG applies if you have any operations

contributing process wastewater in any subcategory covered by

New Source Performance Standar ds (NSPS). If you are unsure

whether you are covered by a promulgated ELG, consult your

NPDES permitting authority (see Exhibit 1

– 1 of the “General

Instructions” of Form 1). You must check “yes” if an applicable ELG

has been promulgated, even if the ELG is being contested in court.

If you believe that a promulgated ELG has been remanded for

reconsideration by a court and does not apply to your operations,

you may answer “no” to item 6.1 and skip to Section 7.

Item 6.2. Complete Item 6.2 by indicating the applicable ELG

category, ELG subcategory, and corresponding regulatory citation.

See example below.

Item 6.3. Indicate whether the limitations in the applicable ELGs are

expressed in terms of production (or other measure of operation).

An ELG is expressed in terms of production (or other measure of

operation) if the limitation is expressed as mass of pollutant per

operational parameter (e.g., “pounds of biological oxygen demand

per cubic foot of logs from which bark is removed,” or “pounds of

total suspended solids per megawatt hour of electrical energy

consumed by smelting furnace.”). An example of an ELG not

expressed in terms of a measure of operation is one which limits

the concentration of pollutants. If you answer “no” to this item, skip

to Section 7.

Item 6.4. For each applicable outfall to which an applicable

production-based ELG applies, list t he estimated level of production

(projection of actual production level, not design), for each of the

first three years of operation. The estimated production level must

be a long-term average estimate (e.g., average production on anApplicable ELGs 

# 6.2 ELG Category ELG

Subcategory Regulatory

Citation

Pulp, Paper,

and

Paperboard

Point Source

Category Secondary Fiber

Non-Deink

Subcategory 40 CFR Part

430, Subpart J

# 2D-3 

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annual basis). If production will vary depending on long-term shifts

in operating schedule or capacity, you may report alternative

production estimates, but you must provide the basis for such

alternatives. If known, report quant ities in units of measurements

used in the applicable ELG. If an ELG specifies a method for

estimating production, you must follow that method.

Section 7. Effluent Characteristics and Tables A through E

General Information. Section 7 requires you to report estimated

flow data for the parameters and pollutants listed in Tables A

through E, located at the end of Form 2D. You are not required to

conduct actual sampling and analysis at this time. If, however, data

from such analyses are available, you must report those data. Note

that no later than 18 months after you begin discharging from the

proposed facility, you must complete and submit quantitative data

for the pollutants and parameters in Tables A through E. However,

you need not report results for tests you have already performed

and reported under the discharge m onitoring requirements of your

NPDES permit.

Complete a set of tables (Tables A through E) for each outfall at

your facility. Be sure to note the EPA Identification Number, facility

name, and outfall number at the top of each table page and any

associated attachments.

Tables A through D require you to report estimated effluent data,

with some exceptions, as discussed further below. Base your

estimates on available in-house or contractors’ engineering reports

or any other studies performed on the proposed facility. Table E

requires you to report quantitative data for the pollutants listed, but

only if it is already available.

Several tables require you to provide estimates for pollutants you

believe will be present in your discharge or will be limited directly by

an ELG or indirectly through promulgated limitations on an indicator

pollutant. Base your determination of whether a pollutant will be

present in your discharge on your knowledge of the proposed

facility’s raw materials, maintenance chemicals, intermediate and

final products, byproducts, and any analyses of any pollutant (you

are required to report it).

For those pollutants you believe will be present in the discharge,

you are to provide the maximum daily and average daily

concentration and total mass and the source of the information. Use

the following codes to report your source information:

Data Source Code

Engineering Study 1

A ctual data from pilot plants 1

Estimates from other engineering

studies 2

Data from other similar plants 3

Best professional estimates 4

Others 5 and specify on

the table



# You may report some or all of your estimates (or actual data when

available) by attaching separate sheets of paper instead of

completing Tables A through E for each of your outfalls, so long as

the sheets contain all of the required information and are similar in

format to Tables A through E. Reporting of Intake Data

If you expect a pollutant to be present solely because of its

presence in your intake water, you must mark “yes” under the

“Intake Water” column of Tables A through D. If you wish to obtain

credits for pollutants or parameters present in your intake water,

insert a separate sheet with a short statement of why you believe

you are eligible (see 40 CFR 122.45(g)).

Reporting of Effluent Data

Report all estimated pollutant or parameter levels as concentration

and as total mass, with the exception of discharge flow,

temperature, and pH.

Use the following abbreviations in the columns requiring “units” in

Tables A through E.

Concentration Mass

ppm = parts per million lbs = pounds

mg/L = milligrams per liter ton = Tons (English tons)

ppb = parts per billion mg = milligrams

μg/L = micrograms per liter g = grams

MPN = most probable number kg = kilograms

per 100 milliliters T = tonnes (metric tons)



# Conventional and Non-Conventional Parameters

Items 7.1 through 7.3 and Table A.

Table A and Item 7.1. All applicants are required to complete

Table A for each outfall, including outfalls discharging only

noncontact cooling water or nonprocess water unless a waiver has

been received or requested from the NPDES permitting authority.

For each parameter listed on Table A, indicate whether a waiver

has been requested. If you have requested a waiver for all

pollutants for a given outfall, check the box indicating this at the top

of Table A.

To request a waiver, submit a written request to the NPDES

permitting authority in advance or with the permit application. The

written request should specify the parameters that should be

waived and for what outfall(s) and why. The NPDES permitting

authority may waive Table A requirements upon a determination

that less stringent reporting requirements are adequate to support

issuance of an NPDES permit. Attach a copy of any waiver

approval notice(s) received, if applicable, to this application.

Answer Item 7.1 by indicating if you are requesting a waiver for any

of your outfalls. If “yes,” continue to Item 7.2. Otherwise, complete

Table A by estimating your maximum daily and average daily

discharge. Provide the source(s) of your information. Also on

Table A, indicate whether you be lieve each of the parameters will

be present in the facility’s intake water. See “Reporting of Intake

Data” above for further information. Skip to Item 7.3.

Item 7.2. Indicate the outfalls for which you have requested a

waiver.

Item 7.3. Indicate if you have provided estimates or actual data for

all Table A parameters for each of your outfalls for which a waiver

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has not been requested and attach the results to your application

package.

Certain Conventional and Non-Conventional Pollutants

Items 7.4 through 7.6 and Table B. Complete one table for each

outfall, including outfalls discharging only noncontact cooling water

or nonprocess wastewater. Check (  ) the box at the top of Table B

if you believe all pollutants listed will be absent in the discharge. If

so, you do not need to complete Table B for the noted outfall. (You

still need to complete Items 7.4 through 7.6.) Otherwise, for each

pollutant listed in Table B, indicate whether you expect it will be

present or absent in the discharge or whether the pollutant is limited

directly by an ELG or indirectly through promulgated limitations or

an indicator pollutant. For example, total suspended solids is used

as an indicator to control the discharge of iron and aluminum. Next,

provide an estimated maximum daily and average daily value,

including the source of the information. If you have quantitative data

available, report it. Also on Table B, indicate whether you believe

the listed pollutants will be present in the facility’s intake water. See

“Reporting of Intake Data” above for further information. Answer

“yes” to Items 7.4 through 7.6 once you have completed the above

tasks.

Toxic Metals, Total Cyanide, and Total Phenols

Items 7.7 and 7.8 and Table C. Complete one table for each

outfall, including outfalls discharging only noncontact cooling water

or nonprocess wastewater. Check (  ) the box at the top of Table C

if you believe all pollutants listed will be absent in the discharge. If

so, you do not need to complete Table C for the noted outfall

(unless you have quantitative data available). You still need to

respond to Items 7.7 and 7.8, however. Otherwise, indicate whether

you believe each pollutant on Table C will be present or absent in

your discharge for each applicable outfall. For those pollutants you

believe will be present, provide an estimated maximum daily and

average daily value and source of the information. (Provide

quantitative data if you have it available.) Also, on Table C, indicate

whether you believe the pollutant is or will be present in your

facility’s intake water. See “Reporting of Intake Data” above for

further information. Answer “yes” to Items 7.7 and 7.8 when you

have completed the above tasks.

Organic Toxic Pollutants

(Gas Chromatography/Mass Spectrometry or GC/MS Fractions)

Items 7.9 through 7.11 and Table D

Item 7.9. Applicants are exempt from the reporting requirements

associated with Table D if they expect to have gross sales of less

than $100,000 per year for the next thr ee years or if they are a coal

mine with expected average production of less than 100,000 tons of

coal per year. If you believe you meet one of the criterions noted,

answer “yes” to Item 7.9, check (  ) the small business box at the

top of Table D, and attach projected sales or production figures.

Skip to Item 7.12 when through.

The sales or production figures must be for the facility that will be

the source of the discharge. The data should not be limited only to

production or sales for the process or processes that will contribute

to the discharge, unless those are the only processes at the facility. For sales data, where intracorporate transfers of goods and

services will be involved, the transfer price per unit should

approximate market process for those goods and services as

closely as possible. If necessary, you may index your sales figures

to the second quarter of 1980 to demonstrate your eligibility for a

small business exemption. You may accomplish this by using the

gross national product price deflator (second quarter of 1980 =

100). This index is available online from the U.S. Department of

Commerce, Bureau of Economic Analysis at

http://bea.gov/national/pdf/SNTables.pdf

.

Item 7.10 and 7.11 and Table D . Complete one table for each

outfall, including outfalls discharging only noncontact cooling water

or nonprocess wastewater. Check (  ) the box at the top of Table D

if you believe all pollutants listed will be absent in the discharge

from the outfall. If so, you do not need to complete Table D for the

noted outfall (unless you have quantitative data available).

Otherwise, for each pollutant listed, indicate whether you believe it

will be present or absent in the discharge. For those you believe will

be present, provide an estimated maximum daily and average daily

value and the source of the information. Also, on Table D, indicate

whether you believe the pollutant is or will be present in your

facility’s intake water. See “Reporting of Intake Data” above for

further information. Finally, answer “yes” to Items 7.10 and 7.11

when you have completed the above tasks.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD)

Item 7.12

Item 7.12. Answer whether the facility uses or manufactures one or

more of the 2,3,7,8-TCDD congeners listed below or if you know or

have reason to believe that TCDD is or may be present in effluent

from any of your outfalls:

A. 2,4,5-trichlorophenoxy acetic acid (2,4,5-T) (CAS # 93-765);

B. 2-(2,4,5-trichlorophenoxy) propanoic acid (Silvex, 2,4,5-TP) (CAS

# 93-72-1);

C. 2-(2,4,5-trichlorophenoxy) ethy l 2,2-dichloropropionate (Erbon)

(CAS # 136-25-4);

D. 0,0-dimethyl 0-(2,4,5-trichlorophenyl) phosphorothioate (Ronnel)

(CAS # 299-84-3); E. 2,4,5-tr ichlorophenol (TCP) (CAS # 95-95-

4); or

F. Hexachlorophene (HCP) (CAS # 70-30-4).

Certain Hazardous Substances and Asbestos

Items 7.13 through 7.14 and Table E

Table E. Complete Table E for each outfall. Check (  ) the box at

the top of Table E if you believe all pollutants listed will be absent in

the discharge. Otherwise, for each pollutant listed in Table E,

indicate whether you believe it will be present or absent in the

discharge. If you have quantitative estimates available for any of

the pollutants listed, provide the maximum daily and average daily

average value and the source of the information. Also, on Table E,

if you believe the pollutant is or will be present in your facility’s

intake water, state so in the “Reason Pollutant Believed Present in

Discharge” column.

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Item 7.13. Check whether for each of your outfalls you have

indicated whether you know or have reason to believe that any

pollutants listed in Table E are discharged.

Item 7.14. Indicate whether you have for each of your outfalls

completed and attached Table E to the application describing the

reasons the applicable pollutant s are expected to be discharged

and providing quantitative data if available.

Intake Credits

Item 7.15. Answer whether you are seeking to obtain credits for any

of the pollutants or parameters listed in Section 7 (Tables A through

E) in your intake water for any of the facility’s outfalls.

Section 8. Engineering Report

Item 8.1. Indicate if any technical evaluations have been conducted

of your wastewater treatment, in cluding engineering reports or pilot

plant studies. If “yes,” continue to Item 8.2. If “no,” skip to Item 8.3.

Item 8.2. Attach the technical evaluation(s) you considered when

responding to Item 8.1 and any related documentation to Form 2D

and then answer “yes” to Item 8.2. The NPDES permit writer will

use this information to determine appropriate treatment methods

and associated permit conditions and limits.

Item 8.3. Answer “yes” if you are aware of any existing plant(s) that

resemble your production processes, wastewater constituents, or

wastewater treatment. If you are unaware of such plants, answer

“no” and skip to Section 9.

Item 8.4. Provide the name and location of any existing plant(s) that

resemble(s) your production facility. You do not need to conduct

any studies to respond to this item.

Section 9. Other Information

Item 9.1. Indicate whether you have attached to the application any

optional information that you would like considered as part of the

application review process. These should be items beyond those

you have already noted as being included in the package. Skip to

Section 10 if you do not have further information to provide.

Item 9.2. List the additional materials attached and note why you

think they should be considered by the NPDES permitting authority

when reviewing your application and developing your permit.

Section 10. Checklist and Certification Statement

Item 10.1. Review the checklist provided. In Column 1, mark the

sections of Form 2D that you have completed and are submitting

with your application. For each section, indicate in column 2

whether you are submitting attachments. Item 10.2. The Clean Water Act provides for severe penalties for

submitting false information on this application form. Section

309(c)(2) of the Clean Water Act pr ovides that “Any person who

knowingly makes any false statement, representation, or

certification in any application, ...shall upon conviction, be punished

by a fine of no more than $10,000 or by imprisonment for not more

than six months or both.”

FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS

APPLICATION TO BE SIGNED AS FOLLOWS:

A. By a responsible corporate officer. For the purpose of this

section, a responsible corporate officer means: (i) A president,

secretary, treasurer, or vice-p resident of the corporation in

charge of a principal business function, or any person who

performs similar policy- or decision-making functions for the

corporation, or (ii) the manager of one or more manufacturing,

production, or operating facilities, provided, the manager is

authorized to make management decisions which govern the

operation of the regulated facility having the explicit or implicit

duty of making major capital investment recommendations, and

initiating and directing other comprehensive measures to assure

long term environmental compliance with environmental laws

and regulations; the manager can ensure that the necessary

systems are established or actions taken to gather complete

and accurate information for permit application requirements;

and where authority to sign documents has been assigned or

delegated to the manager in accordance with corporate

procedures.

B. For partnership or sole proprie torship, by a general partner or

the proprietor, respectively.

C. For a municipality, state, federal, or other public facility, by

either a principal executive office r or ranking elected official.

For purposes of this section, a principal executive officer of a

Federal agency includes: (i) the chief executive officer of the

agency, or (ii) a senior executiv e officer having responsibility for

the overall operations of a principal geographic unit of the

agency (e.g., Regional Administrators of EPA).

END

Submit your completed Form 1, Form 2D, and all associated

attachments to your NPDES permitting authority.

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Exhibit 2D

– 1. Codes for Treatment Units and Di sposal of Wastes Not Discharged

1. PHYSICAL TREATMENT PROCESSES

1–A ................. Ammonia Stripping

1–B ................. Dialysis

1–C ................ Diatomaceous Earth Filtration

1–D ................ Distillation

1–E ................. Electrodialysis

1–F ................. Evaporation

1–G ................ Flocculation

1–H ................ Flotation

1–I .................. Foam Fractionation

1–J ................. Freezing

1–K ................. Gas–Phase Separation

1–L ................. Grinding ( Comminutors ) 1–M ................ Grit Removal

1–N ................ Microstraining

1–O ................ Mixing

1–P ................ Moving Bed Filters

1–Q ................ Multimedia Filtration

1–R ................ Rapid Sand Filtration

1–S ................ Reverse Osmosis ( Hyperfiltration )

1–T ................ Screening

1–U ................ Sedimentation ( Settling )

1–V ................ Slow Sand Filtration

1–W ............... Solvent Extraction

1–X ................ Sorption

2. CHEMICAL TREATMENT PROCESSES

2–A ................. Carbon Adsorption

2–B ................. Chemical Oxidation

2–C ................ Chemical Precipitation

2–D ................ Coagulation

2–E ................. Dechlorination

2–F ................. Disinfection ( Chlorine ) 2–G ................ Disinfection ( Ozone )

2–H ................ Disinfection ( Other )

2–I .................. Electrochemical Treatment

2–J ................. Ion Exchange

2–K ................ Neutralization

2–L ................. Reduction

3. BIOLOGICAL TREATMENT PROCESSES

3–A ................. Activated Sludge

3–B ................. Aerated Lagoons

3–C ................ Anaerobic Treatment

3–D ................ Nitrification–Denitrification 3–E ................ Pre-Aeration

3–F ................ Spray Irrigation/Land Application

3–G ................ Stabilization Ponds

3–H ................ Trickling Filtration

4. OTHER PROCESSES

4–A ................. Discharge to Surface Water

4–B ................. Ocean Discharge Through Outfall 4–C ............... Reuse/Recycle of Treated Effluent

4–D ............... Underground Injection

5. SLUDGE TREATMENT AND DISPOSAL PROCESSES

5–A ................. Aerobic Digestion

5–B ................. Anaerobic Digestion

5–C ................ Belt Filtration

5–D ................ Centrifugation

5–E ................. Chemical Conditioning

5–F ................. Chlorine Treatment

5–G ................ Composting

5–H ................ Drying Beds

5–I .................. Elutriation

5–J ................. Flotation Thickening

5–K ................. Freezing

5–L ................. Gravity Thickening 5–M ................ Heat Drying

5–N ................ Heat Treatment

5–O ................ Incineration

5–P ................ Land Application

5–Q ................ Landfill

5–R ................ Pressure Filtration

5–S ................ Pyrolysis

5–T ................ Sludge Lagoons

5–U ................ Vacuum Filtration

5–V ................ Vibration

5–W ............... Wet Oxidation

# 2D-7 

# Contains Nonbinding Recommendations

Draft Application Forms

– Not for Implementation

Exhibit 2D

– 2. Example Line Drawing

# Contains Nonbinding Recommendations

Draft Application Forms

– Not for Implementation



# This page intentionally left blank.

# EPA Form 3510-2D (Revised <INSERT DATE>) Page 1 EPA Identification Nu mber Facility Name Form Approved

OMB No. <INSERT NO.>

Form Expires <INSERT DATE>



# Contains Nonbinding Recommendations

Draft Application Forms

– Not for Implementation Form

2D

NPDES 

# U.S. Environmental Protection Agency

Application for NPDES Permit to Discharge Wastewater

NEW MANUFACTURING, COMMERCIAL, MINING, OR SILVICULTURAL FACILITY THAT HAS

NOT YET COMMENCED DISCHARGE OF PROCESS WASTEWATER

SECTION 1. EXPECTED OUTFALL LOCATION (40 CFR 122.21(k)(1))Outfall Location 

# 1.1 Provide information on each of the facility’s outfalls in the table below.

Outfall

Number Receiving Water Name Latitude Longitude

Degrees Minutes Seconds Degrees Minutes Seconds

Collection Method Information

Horizontal Collection Method (Type of

method/device used to identify the coordinates)



# Scale (Proportional distance on the ground for

one unit of measure) 

#  Not Applicable

Horizontal Reference Datum

(Coordinate reference system) 

#  NAD 27  NAD 83  WGS85  Other (specify)

Outfall

Number Receiving Water Name Latitude Longitude

Degrees Minutes Seconds Degrees Minutes Seconds

Collection Method Information

Horizontal Collection Method (Type of

method/device used to identify the coordinates)



# Scale (Proportional distance on the ground for

one unit of measure) 

#  Not Applicable

Horizontal Reference Datum

(Coordinate reference system) 

#  NAD 27  NAD 83  WGS85  Other (specify)

Outfall

Number Receiving Water Name Latitude Longitude

Degrees Minutes Seconds Degrees Minutes Seconds

Collection Method Information

Horizontal Collection Method (Type of

method/device used to identify the coordinates)



# Scale (Proportional distance on the ground for

one unit of measure) 

#  Not Applicable

Horizontal Reference Datum

(Coordinate reference system) 

#  NAD 27  NAD 83  WGS85  Other (specify)

SECTION 2. EXPECTED DISCHARGE DATE (40 CFR 122.21(k)(2))ExpectedDischargeDate 

# 2.1 Month Day Year

# EPA Form 3510-2D (Revised <INSERT DATE>) Page 2 EPA Identification Nu mber Facility Name Form Approved

OMB No. <INSERT NO.>

Form Expires <INSERT DATE>



# Contains Nonbinding Recommendations

Draft Application Forms

– Not for Implementation SECTION 3. AVERAGE FLOWS AND TREATMENT (40 CFR 122.21(k)(3)(i))Average Flows and Treatment 

# 3.1 For each outfall identified under Item 1.1, provide average flow and treatment information. Add additional pages as

necessary.

Outfall Number _________

Operations Contributing to Flow

Operation Average Flow

mgd

mgd

mgd

mgd

mgd

Treatment Units

Description

(Include size, flow rate through each treatment unit,

retention time, etc.) Code from

Exhibit 2D-1 Final Disposal of Solid or Liquid

Wastes Other Than by Discharge

Outfall Number _________

Operations Contributing to Flow

Operation Average Flow

mgd

mgd

mgd

mgd

mgd

Treatment Units

Description

(Include size, flow rate through each treatment unit,

retention time, etc.) Code from

Exhibit 2D-1 Final Disposal of Solid or Liquid

Wastes Other Than by Discharge

# EPA Form 3510-2D (Revised <INSERT DATE>) Page 3 EPA Identification Nu mber Facility Name Form Approved

OMB No. <INSERT NO.>

Form Expires <INSERT DATE>



# Contains Nonbinding Recommendations

Draft Application Forms

– Not for ImplementationAverage Flows and Treatment Continued 

# 3.1 Outfall Number __________

Cont. Operations Contributing to Flow

Operation Average Flow

mgd

mgd

mgd

mgd

mgd

Treatment Units

Description

(Include size, flow rate through each treatment unit,

retention time, etc.) 

# Code from

Exhibit 2D-1 Final Disposal of Solid or Liquid

Wastes Other Than by Discharge

SECTION 4. LINE DRAWING (40 CFR 122.21(k)(3)(ii))LineDrawing 

# 4.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water

balance? (See Instructions for drawing requirements. See Exhibit 2D-2 at end of Instructions for example.)



#  Yes 

#  No

SECTION 5. INTERMITTENT OR SEASO NAL FLOWS (40 CFR 122.21(k)(3)(iii))Intermittent or Seasonal Flows 

# 5.1 Except for stormwater runoff, leaks, or spills, are any expected discharges described in Sections 1 and 3 intermittent or

seasonal?



#  Yes 

#  No  SKIP to Section 6.

5.2 Provide information on intermittent or seasonal flows for each applicable outfall. Attach additional pages, if necessary.

Outfall

Number Operations

(list) Frequency Rate and Volume

Duration Average

Days/Week Average

Months/Year Maximum Daily

Discharge Maximum Total

Volume

days/week months/year mgd gallons days

days/week months/year mgd gallons days

days/week months/year mgd gallons days



# Outfall

Number Operations

(list) Frequency Rate and Volume

Duration Average

Days/Week Average

Months/Year Maximum Daily

Discharge Maximum Total

Volume

days/week months/year mgd gallons days

days/week months/year mgd gallons days

days/week months/year mgd gallons days

# EPA Form 3510-2D (Revised <INSERT DATE>) Page 4 EPA Identification Nu mber Facility Name Form Approved

OMB No. <INSERT NO.>

Form Expires <INSERT DATE>



# Contains Nonbinding Recommendations

Draft Application Forms

– Not for ImplementationIntermittent or SeasonalFlows Continued 

# Outfall

Number Operations

(list) Frequency Rate and Volume

Duration Average

Days/Week Average

Months/Year Maximum Daily

Discharge Maximum Total

Volume

days/week months/year mgd gallons days

days/week months/year mgd gallons days

days/week months/year mgd gallons days



# SECTION 6. PRODUCTION (40 CFR 122.21(k)(4))Production 

# 6.1 Do any ELGs promulgated by EPA under CWA Section 304 apply to your facility?



#  Yes 

#  No  SKIP to Section 7.

6.2 Provide the following information on applicable ELGs.

ELG Category ELG Subcategory Regulatory Citation



# 6.3 Are the limitations in the applicable ELGs expressed in terms of production (or other measure of operation)?



#  Yes 

#  No  SKIP to Section 7.

6.4 Provide an expected measure of average daily producti on expressed in terms and units of applicable ELGs.

Expected Actual Average Daily Production for First Three Years

Outfall

Number Year Operation, Product, or Material Quantity Per Day

(Note basis if applicable.) 

# Unit of Measure

Year 1

Year 2

Year 3

Year 1

Year 2

Year 3

Year 1

Year 2

Year 3

# EPA Form 3510-2D (Revised <INSERT DATE>) Page 5 EPA Identification Nu mber Facility Name Form Approved

OMB No. <INSERT NO.>

Form Expires <INSERT DATE>



# Contains Nonbinding Recommendations

Draft Application Forms

– Not for Implementation SECTION 7. EFFLUENT CHARACTERISTICS (40 CFR 122.21(k)(5))Effluent Characteristics 

# See the Instructions to determine the parameters and pollutants y ou are required to monitor and, in turn, the tables you must

complete. Note that not all applicants need to complete each table.

Table A. Conventional and Non-Conventional Parameters

7.1 Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A parameters for any of

your outfalls?



#  Yes 

#  No  SKIP to Item 7.3.

7.2 If yes, indicate the applicable outfalls below. Attach waiver request and other required information to the application.

Outfall Number ________ Outfall Number ________ Outfall Number ________

7.3 Have you have provided estimates or actual data for all Table A parameters for each of your outfalls for which a waiver

has not been requested and attached the results to this application package.



#  Yes 

#  No; A waiver has been requested from my

NPDES permitting authority for all parameters

at all outfalls.

Table B. Certain Conventional and Non-Conventional Pollutants

7.4 Have you checked “Believed Present” for all pollutants listed in Table B that are limited directly or indirectly by an

applicable ELG?



#  Yes 

#  No

7.5 Have you checked “Believed Present” or “Believed Absent” for all remaining pollutants listed in Table B?



#  Yes 

#  No

7.6 Have you provided estimated data for those Table B pollutant s for which you have indicated are “Believed Present” in

your discharge?



#  Yes 

#  No

Table C. Toxic Metals, Total Cyanide, and Total Phenols

7.7 Have you indicated whether pollutants are “Believed Present” or “Believed Absent” for all pollutants listed on Table C for

all outfalls?



#  Yes 

#  No

7.8 Have you completed Table C by providing estimated data for pollutants you indicated are “Believed Present”, including

the source of the information, for each applicable outfall?



#  Yes 

#  No

Table D. Organic Toxic Pollutants (GS/MS Fractions)

7.9 Do you qualify for a small business exemption un der the criteria specified in the Instructions?



#  Yes  Note that you qualify at the top of Table D

then SKIP to Item 7.12. 

#  No

7.10 Have you indicated whether pollutants are “Believed Present ” or “Believed Absent” for all pollutants listed on Table D for

all outfalls?



#  Yes 

#  No

7.11 Have you completed Table D by providing estimated data for pollutants you indicated are “Believed Present”, including

the source of the information, for each applicable outfall?



#  Yes 

#  No

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD)

7.12 Does the facility use or manufacture one or more of the 2,3,7,8-TCDD congeners listed in the Instructions, or do you

know or have reason to believe that TCDD is or ma y be present in effluent from any of your outfalls?



#  Yes 

#  No

# EPA Form 3510-2D (Revised <INSERT DATE>) Page 6 EPA Identification Nu mber Facility Name Form Approved

OMB No. <INSERT NO.>

Form Expires <INSERT DATE>



# Contains Nonbinding Recommendations

Draft Application Forms

– Not for ImplementationEffluent Characteristics Continued 

# Table E. Certain Hazardous Substances and Asbestos

7.13 Have you indicated whether pollutants are “Believed Present” or “Believed Absent” for all pollutants listed in Table E for

all outfalls?



#  Yes 

#  No

7.14 Have you completed Table E by reporting the reason the pollutants are expected to be present and available

quantitative data for pollutants you indicated are “Believed Present” for each applicable outfall?



#  Yes 

#  No

Intake Credits, Tables A through E

7.15 Are you applying for net credits for the presence of any of the pollutants on Tables A through E for any of your outfalls?



#  Yes  Consult with your NPDES permitting

authority. 

#  No

SECTION 8. ENGINEERING REPORT (40 CFR 122.21(k)(6))Engineering Report 

# 8.1 Do you have any technical evaluations of your wastew ater treatment, including engineer ing reports or pilot plant

studies?



#  Yes 

#  No  SKIP to Item 8.3.

8.2 Have you provided the technical evaluation and all related documents to this application package?



#  Yes 

#  No

8.3 Are you aware of any existing plant(s) that resemble production processes, wastewater constituents, or wastewater

treatment at your facility?



#  Yes 

#  No  SKIP to Section 9.Engineering ReportContinued 

# 8.4 Provide the name and location of the similar plants.

Name of Similar Plants Location of Similar Plants

SECTION 9. OTHER INFORMATION (40 CFR 122.21(k)(7))Other Information 

# 9.1 Have you attached any optional information that you woul d like considered as part of the application review process

(i.e., material beyond that which you have already noted in the application as being attached)?



#  Yes 

#  No  SKIP to Section 10.

9.2 List the additional items and briefly note why you have included them.

1.

2.

3.

4.

5.

# EPA Form 3510-2D (Revised <INSERT DATE>) Page 7 EPA Identification Nu mber Facility Name Form Approved

OMB No. <INSERT NO.>

Form Expires <INSERT DATE>



# Contains Nonbinding Recommendations

Draft Application Forms

– Not for Implementation SECTION 10. CHECKLIST AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))Checklist and Certification Statement 

# 10.1 In Column 1 below, mark the Form 2D sections you have completed and are submitting with your application. For each

section, specify in Column 2 the attachments you are enclosi ng. Note that not all applicants are required to complete all

sections or tables.

Column 1 Column 2



#  Section 1 

#  w/attachments (e.g., responses for additional outfalls)



#  Section 2 

#  w/attachments



#  Section 3 

#  w/attachments



#  Section 4 

#  w/line drawing 

#  w/additional attachments



#  Section 5 

#  w/attachments



#  Section 6 

#  w/attachments



#  Section 7 

#  w/Table A waiver

request or approval 

#  Table A



#  Table B 

#  Table C



#  Table D 

#  Table E



#  w/other attachments



#  Section 8 

#  w/technical evaluations and related attachments



#  Section 9 

#  w/optional

information



#  Section 10

10.2 I certify under penalty of law that this document and all atta chments were prepared under my direction or supervision in

accordance with a system designed to assure that qualif ied personnel properly gather and evaluate the information

submitted. Based on my inquiry of the person or per sons who manage the system, or those persons directly

responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,

accurate, and complete. I am aware that there are significant penalties for submitting false information, including the

possibility of fine and imprisonment for knowing violations.

Name (first and last) Official Title

Signature Date SignedEPA Form 3510-2D (Revised <INSERT DATE>)Page 8EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE A. CONVENTIONAL AND NON-CONVENTIONAL PARAMETER ESTIMATES (40 CFR 122.21(k)(5)(i))1PollutantWaiverRequested(if applicable)UnitsEffluent DataIntake WaterMaximum DailyDischarge(required)Average DailyDischarge(if available)Source of Information(Use codes in Instructions.)Believed Present?(Check only one response perparameter.)Check here if you have applied to your NPDES authority for a waiver forallof the pollutants listed on this table for the noted outfall.1.Biochemical OxygenDemand (BOD5)ConcentrationYesNoMass2.Chemical Oxygen Demand(COD)ConcentrationYesNoMass3.Total Organic Carbon(TOC)ConcentrationYesNoMass4.Total Suspended Solids(TSS)ConcentrationYesNoMass5. Ammonia (as N)ConcentrationYesNoMass6. FlowRateYesNo7.Temperature (winter)°C °CYesNoTemperature (summer)°C °C8.pH (minimum)Standard Units s.u.YesNopH (maximum)Standard Units s.u.1Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR Part 136for the analysis of pollutants or pollutant parameters orrequired under 40 CFR chapter I, subchapter N orO. See Instructions and 40 CFR 122.21(e)(3).ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationThis page intentionally left blank.EPA Form 3510-2D (Revised <INSERT DATE>)Page 10EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE B. CERTAIN CONVENTIONAL AND NON-CONVENTIONAL POLLUTANTS (40 CFR 122.21(k)(5)(ii))1PollutantPresence or Absence(check one)Estimated Data for Pollutants Expected to be Present or Limited by an ELG(Provide both concentration and mass estimates for each pollutant.)BelievedPresentBelievedAbsentEffluentIntake WaterUnitsMaximum DailyDischarge(required)Average DailyDischarge(if available)Source of Information(Use codes in Instructions.)Believed Present?(Check only oneresponse per item.)1.Bromide(24959-67-9)ConcentrationYesNoMass2.Chlorine, TotalResidualConcentrationYesNoMass3. ColorConcentrationYesNoMass4. Fecal ColiformConcentrationYesNoMass5.Fluoride(16984-48-8)ConcentrationYesNoMass6. Nitrate-NitriteConcentrationYesNoMass7.Nitrogen, TotalOrganic (as N)ConcentrationYesNoMass8. Oil and GreaseConcentrationYesNoMass9.Phosphorus (as P),Total (7723-14-0)ConcentrationYesNoMass10.Sulfate (as SO4)(14808-79-8)ConcentrationYesNoMass11. Sulfide (as S)ConcentrationYesNoMassEPA Form 3510-2D (Revised <INSERT DATE>)Page 11EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE B. CERTAIN CONVENTIONAL AND NON-CONVENTIONAL POLLUTANTS (40 CFR 122.21(k)(5)(ii))1PollutantPresence or Absence(check one)Estimated Data for Pollutants Expected to be Present or Limited by an ELG(Provide both concentration and mass estimates for each pollutant.)BelievedPresentBelievedAbsentEffluentIntake WaterUnitsMaximum DailyDischarge(required)Average DailyDischarge(if available)Source of Information(Use codes in Instructions.)Believed Present?(Check only oneresponse per item.)12.Sulfite (as SO3)(14265-45-3)ConcentrationYesNoMass13. SurfactantsConcentrationYesNoMass14.Aluminum, Total(7429-90-5)ConcentrationYesNoMass15.Barium, Total(7440-39-3)ConcentrationYesNoMass16.Boron, Total(7440-42-8)ConcentrationYesNoMass17.Cobalt, Total(7440-48-4)ConcentrationYesNoMass18.Iron, Total(7439-89-6)ConcentrationYesNoMass19.Magnesium, Total(7439-95-4)ConcentrationYesNoMass20.Molybdenum, Total(7439-98-7)ConcentrationYesNoMass21.Manganese, Total(7439-96-5)ConcentrationYesNoMass22.Tin, Total(7440-31-5)ConcentrationYesNoMassEPA Form 3510-2D (Revised <INSERT DATE>)Page 12EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE B. CERTAIN CONVENTIONAL AND NON-CONVENTIONAL POLLUTANTS (40 CFR 122.21(k)(5)(ii))1PollutantPresence or Absence(check one)Estimated Data for Pollutants Expected to be Present or Limited by an ELG(Provide both concentration and mass estimates for each pollutant.)BelievedPresentBelievedAbsentEffluentIntake WaterUnitsMaximum DailyDischarge(required)Average DailyDischarge(if available)Source of Information(Use codes in Instructions.)Believed Present?(Check only oneresponse per item.)23.Titanium, Total(7440-32-6)ConcentrationYesNoMass24. Radioactivity24.1 Alpha, TotalConcentrationYesNoMass24.2 Beta, TotalConcentrationYesNoMass24.3. Radium, TotalConcentrationYesNoMass24.4 Radium 226, TotalConcentrationYesNoMass1Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR Part 136for the analysis of pollutants or pollutant parameters orrequired under 40 CFR chapter I, subchapter Nor O. See Instructions and 40 CFR 122.21(e)(3).ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationThis page intentionally left blank.EPA Form 3510-2D (Revised <INSERT DATE>)Page 14EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE C. TOXIC METALS, TOTAL CYANIDE, ANDTOTAL PHENOLS (40 CFR 122.21(k)(5)(iii)(A))1Pollutant(CAS Number, if available)Presence or Absence(check one)Estimated Data for Pollutants Expected to be Present in Discharge(Provide both concentration and mass estimates for each pollutant.)BelievedPresentBelievedAbsentEffluentIntake WaterUnitsMaximumDailyDischarge(required)AverageDailyDischarge(if available)Source of Information(Use codes in Instructions.)Believed Present?(Check only oneresponse per pollutant.)Check () here if you believe all pollutants listed to be absent fromthe discharge. You need not complete Table C for the noted outfallunlessyou have quantitative data available.1. Antimony, Total(7440-36-0)ConcentrationYesNoMass2. Arsenic, Total(7440-38-2)ConcentrationYesNoMass3. Beryllium, Total(7440-41-7)ConcentrationYesNoMass4. Cadmium, Total(7440-43-9)ConcentrationYesNoMass5. Chromium, Total(7440-47-3)ConcentrationYesNoMass6. Copper, Total(7440-50-8)ConcentrationYesNoMass7. Lead, Total(7439-92-1)ConcentrationYesNoMass8. Mercury, Total(7439-97-6)ConcentrationYesNoMass9. Nickel, Total(7440-02-0)ConcentrationYesNoMass10. Selenium, Total(7782-49-2)ConcentrationYesNoMass11. Silver, Total(7440-22-4)ConcentrationYesNoMass12. Thallium, Total(7440-28-0)ConcentrationYesNoMass13. Zinc, Total(7440-66-6)ConcentrationYesNoMass14. Cyanide, Total(57-12-5)ConcentrationYesNoMass15. Phenols, TotalConcentrationYesNoMass1Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR Part 136for the analysis of pollutants or pollutant parameters orrequired under 40 CFR chapter I, subchapter N orO. See Instructions and 40 CFR 122.21(e)(3).ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationThis page intentionally left blank.EPA Form 3510-2D (Revised <INSERT DATE>)Page 16EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE D. ORGANIC TOXIC POLLUTANTS (GasChromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1Pollutant(CAS Number, if available)Presence or Absence(check one)Estimated Data for Pollutants Expected to be Present in Discharge(Provide both concentration and mass estimates for each pollutant.)BelievedPresentBelievedAbsentUnitsEffluentIntake WaterMaximumDailyDischargeAverageDailyDischargeSource ofInformation(Use codes in Instructions.)Believed Present?(Check only one response perpollutant.)Check () here if all pollutants listed in Table D are expected to be absent from your facility’s discharge.Check () here if the facility believes it is exempt from TableD reporting requirements because it is a qualified small business.See the Instructions for exemption criteria and for listof materials you must attach to the application.Note:If you check either of the above boxes, you do not need to complete Table D for the noted outfallunlessyou have quantitative data available.1. Organic Toxic Pollutants (GC/MS Fraction—Volatile Compounds)1.1 Acrolein(107-02-8)ConcentrationYesNoMass1.2 Acrylonitrile(107-13-1)ConcentrationYesNoMass1.3 Benzene(71-43-2)ConcentrationYesNoMass1.4 Bromoform(75-25-2)ConcentrationYesNoMass1.5 Carbon Tetrachloride(56-23-5)ConcentrationYesNoMass1.6 Chlorobenzene(108-90-7)ConcentrationYesNoMass1.7 Chlorodibromomethane(124-48-1)ConcentrationYesNoMass1.8 Chloroethane(75-00-3)ConcentrationYesNoMass1.9 2-Chloroethylvinyl Ether(110-75-8)ConcentrationYesNoMass1.10 Chloroform (67-66-3)ConcentrationYesNoMass1.11 Dichlorobromomethane(75-27-4)ConcentrationYesNoMassEPA Form 3510-2D (Revised <INSERT DATE>)Page 17EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE D. ORGANIC TOXIC POLLUTANTS (GasChromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1Pollutant(CAS Number, if available)Presence or Absence(check one)Estimated Data for Pollutants Expected to be Present in Discharge(Provide both concentration and mass estimates for each pollutant.)BelievedPresentBelievedAbsentUnitsEffluentIntake WaterMaximumDailyDischargeAverageDailyDischargeSource ofInformation(Use codes in Instructions.)Believed Present?(Check only one response perpollutant.)1.12 1,1-Dichloroethane(75-34-3)ConcentrationYesNoMass1.13 1,2-Dichloroethane(107-06-2)ConcentrationYesNoMass1.14 1,1-Dichloroethylene(75-35-4)ConcentrationYesNoMass1.15 1,2-Dichloropropane(78-87-5)ConcentrationYesNoMass1.16 1,3-Dichloropropylene(542-75-6)ConcentrationYesNoMass1.17 Ethylbenzene(100-41-4)ConcentrationYesNoMass1.18 Methyl Bromide(74-83-9)ConcentrationYesNoMass1.19 Methyl Chloride(74-87-3)ConcentrationYesNoMass1.20 Methylene Chloride(75-09-2)ConcentrationYesNoMass1.21 1,1,2,2-Tetrachloroethane(79-34-5)ConcentrationYesNoMass1.22 Tetrachloroethylene(127-18-4)ConcentrationYesNoMass1.23 Toluene(108-88-3)ConcentrationYesNoMass1.24 1,2-Trans-Dichloroethylene(156-60-5)ConcentrationYesNoMassEPA Form 3510-2D (Revised <INSERT DATE>)Page 18EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE D. ORGANIC TOXIC POLLUTANTS (GasChromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1Pollutant(CAS Number, if available)Presence or Absence(check one)Estimated Data for Pollutants Expected to be Present in Discharge(Provide both concentration and mass estimates for each pollutant.)BelievedPresentBelievedAbsentUnitsEffluentIntake WaterMaximumDailyDischargeAverageDailyDischargeSource ofInformation(Use codes in Instructions.)Believed Present?(Check only one response perpollutant.)1.251,1,1-Trichloroethane(71-55-6)ConcentrationYesNoMass1.261,1,2-Trichloroethane(79-00-5)ConcentrationYesNoMass1.27Trichloroethylene(79-01-6)ConcentrationYesNoMass1.28Vinyl Chloride(75-01-4)ConcentrationYesNoMass2. Organic Toxic Pollutants (GC/MS Fraction—Acid Compounds)2.1 2-Chlorophenol(95-57-8)ConcentrationYesNoMass2.2 2,4-Dichlorophenol(120-83-2)ConcentrationYesNoMass2.3 2,4-Dimethylphenol(105-67-9)ConcentrationYesNoMass2.4 4,6-Dinitro-O-Cresol(534-52-1)ConcentrationYesNoMass2.5 2,4-Dinitrophenol(51-28-5)ConcentrationYesNoMass2.6 2-Nitrophenol(88-75-5)ConcentrationYesNoMass2.7 4-Nitrophenol(100-02-7)ConcentrationYesNoMass2.8 p-Chloro-m-Cresol(59-50-7)ConcentrationYesNoMass2.9 Pentachlorophenol(87-86-5)ConcentrationYesNoMassEPA Form 3510-2D (Revised <INSERT DATE>)Page 19EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE D. ORGANIC TOXIC POLLUTANTS (GasChromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1Pollutant(CAS Number, if available)Presence or Absence(check one)Estimated Data for Pollutants Expected to be Present in Discharge(Provide both concentration and mass estimates for each pollutant.)BelievedPresentBelievedAbsentUnitsEffluentIntake WaterMaximumDailyDischargeAverageDailyDischargeSource ofInformation(Use codes in Instructions.)Believed Present?(Check only one response perpollutant.)2.10 Phenol(108-95-2)ConcentrationYesNoMass2.11 2,4,6-Trichlorophenol(88-05-2)ConcentrationYesNoMass3. Organic Toxic Pollutants (GC/MS Fraction—Base /Neutral Compounds)3.1 Acenaphthene(83-32-9)ConcentrationYesNoMass3.2 Acenaphtylene(208-96-8)ConcentrationYesNoMass3.3 Anthracene(120-12-7)ConcentrationYesNoMass3.4 Benzidine(92-87-5)ConcentrationYesNoMass3.5 Benzo (a) Anthracene(56-55-3)ConcentrationYesNoMass3.6 Benzo (a) Pyrene(50-32-8)ConcentrationYesNoMass3.7 3,4-Benzofluoranthene(205-99-2)ConcentrationYesNoMass3.8 Benzo (ghi) Perylene(191-24-2)ConcentrationYesNoMass3.9 Benzo (k) Fluoranthene(207-08-9)ConcentrationYesNoMass3.10 Bis (2-Chloroethoxy) Methane(111-91-1)ConcentrationYesNoMass3.11 Bis (2-Chloroethyl) Ether(111-44-4)ConcentrationYesNoMassEPA Form 3510-2D (Revised <INSERT DATE>)Page 20EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE D. ORGANIC TOXIC POLLUTANTS (GasChromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1Pollutant(CAS Number, if available)Presence or Absence(check one)Estimated Data for Pollutants Expected to be Present in Discharge(Provide both concentration and mass estimates for each pollutant.)BelievedPresentBelievedAbsentUnitsEffluentIntake WaterMaximumDailyDischargeAverageDailyDischargeSource ofInformation(Use codes in Instructions.)Believed Present?(Check only one response perpollutant.)3.12 Bis (2-Chloroisopropyl) Ether(102-80-1)ConcentrationYesNoMass3.13 Bis (2-Ethylhexyl) Phthalate(117-81-7)ConcentrationYesNoMass3.14 4-Bromophenyl Phenyl Ether(101-55-3)ConcentrationYesNoMass3.15 Butyl Benzyl Phthalate(85-68-7)ConcentrationYesNoMass3.16 2-Chloronaphthalene(91-58-7)ConcentrationYesNoMass3.17 4-Chlorophenyl Phenyl Ether(7005-72-3)ConcentrationYesNoMass3.18 Chrysene(218-01-9)ConcentrationYesNoMass3.19 Dibenzo (a,h) Anthracene(53-70-3)ConcentrationYesNoMass3.20 1,2-Dichlorobenzene(95-50-1)ConcentrationYesNoMass3.21 1,3-Dichlorobenzene(541-73-1)ConcentrationYesNoMass3.22 1,4-Dichlorobenzene(106-46-7)ConcentrationYesNoMass3.23 3,3-Dichlorobenzidine(91-94-1)ConcentrationYesNoMass3.24 Diethyl Phthalate(84-66-2)ConcentrationYesNoMassEPA Form 3510-2D (Revised <INSERT DATE>)Page 21EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE D. ORGANIC TOXIC POLLUTANTS (GasChromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1Pollutant(CAS Number, if available)Presence or Absence(check one)Estimated Data for Pollutants Expected to be Present in Discharge(Provide both concentration and mass estimates for each pollutant.)BelievedPresentBelievedAbsentUnitsEffluentIntake WaterMaximumDailyDischargeAverageDailyDischargeSource ofInformation(Use codes in Instructions.)Believed Present?(Check only one response perpollutant.)3.25 Dimethyl Phthalate(131-11-3)ConcentrationYesNoMass3.26 Di-N-Butyl Phthalate(84-74-2)ConcentrationYesNoMass3.27 2,4-Dinitrotoluene(121-14-2)ConcentrationYesNoMass3.28 2,6-Dinitrotoluene(606-20-2)ConcentrationYesNoMass3.29 Di-N-Octyl Phthalate(117-84-0)ConcentrationYesNoMass3.30 1,2-Diphenylhydrazine(as Azobenzene) (122-66-7)ConcentrationYesNoMass3.31 Fluoranthene(206-44-0)ConcentrationYesNoMass3.32 Fluorene(86-73-7)ConcentrationYesNoMass3.33 Hexachlorobenzene(118-74-1)ConcentrationYesNoMass3.34 Hexachlorobutadiene(87-68-3)ConcentrationYesNoMass3.35 Hexachlorocyclopentadiene(77-47-4)ConcentrationYesNoMass3.36 Hexachloroethane(67-72-1)ConcentrationYesNoMass3.37. Indeno (1,2,3-cd) Pyrene(193-39-5)ConcentrationYesNoMassEPA Form 3510-2D (Revised <INSERT DATE>)Page 22EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE D. ORGANIC TOXIC POLLUTANTS (GasChromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1Pollutant(CAS Number, if available)Presence or Absence(check one)Estimated Data for Pollutants Expected to be Present in Discharge(Provide both concentration and mass estimates for each pollutant.)BelievedPresentBelievedAbsentUnitsEffluentIntake WaterMaximumDailyDischargeAverageDailyDischargeSource ofInformation(Use codes in Instructions.)Believed Present?(Check only one response perpollutant.)3.38Isophorone(78-59-1)ConcentrationYesNoMass3.39Naphthalene(91-20-3)ConcentrationYesNoMass3.40Nitrobenzene(98-95-3)ConcentrationYesNoMass3.41N-Nitrosodimethylamine(62-75-9)ConcentrationYesNoMass3.42N-Nitrosodi-N-Propylamine(621-64-7)ConcentrationYesNoMass3.43N-Nitrosodiphenylamine(86-30-6)ConcentrationYesNoMass3.44Phenanthrene(85-01-8)ConcentrationYesNoMass3.45Pyrene(129-00-0)ConcentrationYesNoMass3.461,2,4-Trichlorobenzene(120-82-1)ConcentrationYesNoMass4. Organic Toxic Pollutants (GC/MS Fraction—Pesticides)4.1. Aldrin(309-00-2)ConcentrationYesNoMass4.2α-BHC(319-84-6)ConcentrationYesNoMass4.3β-BHC(319-85-7)ConcentrationYesNoMass4.4γ-BHC(58-89-9)ConcentrationYesNoMassEPA Form 3510-2D (Revised <INSERT DATE>)Page 23EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE D. ORGANIC TOXIC POLLUTANTS (GasChromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1Pollutant(CAS Number, if available)Presence or Absence(check one)Estimated Data for Pollutants Expected to be Present in Discharge(Provide both concentration and mass estimates for each pollutant.)BelievedPresentBelievedAbsentUnitsEffluentIntake WaterMaximumDailyDischargeAverageDailyDischargeSource ofInformation(Use codes in Instructions.)Believed Present?(Check only one response perpollutant.)4.5δ-BHC(319-86-8)ConcentrationYesNoMass4.6 Chlordane(57-74-9)ConcentrationYesNoMass4.7 4,4’-DDT(50-29-3)ConcentrationYesNoMass4.8 4,4’-DDE(72-55-9)ConcentrationYesNoMass4.9 4,4’-DDD(72-54-8)ConcentrationYesNoMass4.10 Dieldrin(60-57-1)ConcentrationYesNoMass4.11α-Enosulfan(115-29-7)ConcentrationYesNoMass4.12β-Endosulfan(115-29-7)ConcentrationYesNoMass4.13 Endosulfan Sulfate(1031-07-8)ConcentrationYesNoMass4.14 Endrin(72-20-8)ConcentrationYesNoMass4.15 Endrin Aldehyde(7421-93-4)ConcentrationYesNoMassEPA Form 3510-2D (Revised <INSERT DATE>)Page 24EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE D. ORGANIC TOXIC POLLUTANTS (GasChromatography/Mass Spectrometry or GC/MS Fractions) (40 CFR 122.21(k)(5)(iii)(B))1Pollutant(CAS Number, if available)Presence or Absence(check one)Estimated Data for Pollutants Expected to be Present in Discharge(Provide both concentration and mass estimates for each pollutant.)BelievedPresentBelievedAbsentUnitsEffluentIntake WaterMaximumDailyDischargeAverageDailyDischargeSource ofInformation(Use codes in Instructions.)Believed Present?(Check only one response perpollutant.)4.16 Heptachlor(76-44-8)ConcentrationYesNoMass4.17 Heptachlor Epoxide(1024-57-3)ConcentrationYesNoMass4.18 PCB-1242(53469-21-9)ConcentrationYesNoMass4.19 PCB-1254(11097-69-1)ConcentrationYesNoMass4.20 PCB-1221(11104-28-2)ConcentrationYesNoMass4.21 PCB-1232(11141-16-5)ConcentrationYesNoMass4.22 PCB-1248(12672-29-6)ConcentrationYesNoMass4.23 PCB-1260(11096-82-5)ConcentrationYesNoMass4.24 PCB-1016(12674-11-2)ConcentrationYesNoMass4.25 Toxaphene(8001-35-2)ConcentrationYesNoMass1Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR Part 136for the analysis of pollutants or pollutant parameters orrequired under 40 CFR chapter I, subchapter Nor O. See Instructions and 40 CFR 122.21(e)(3).ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationThis page intentionally left blank.EPA Form 3510-2D (Revised <INSERT DATE>)Page 26EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE E. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS (40 CFR 122.21(k)(5)(v))1PollutantPresence or Absence(check one)Reason Pollutant Believed Present in DischargeAvailable Quantitative Data(specify units)BelievedPresentBelievedAbsent1. Asbestos2. Acetaldehyde3. Allyl alcohol4. Allyl chloride5. Amyl acetate6. Aniline7. Benzonitrile8. Benzyl chloride9. Butyl acetate10. Butylamine11. Captan12. Carbaryl13. Carbofuran14. Carbon disulfide15. Chlorpyrifos16. Coumaphos17. Cresol18. Crotonaldehyde19. CyclohexaneEPA Form 3510-2D (Revised <INSERT DATE>)Page 27EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE E. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS (40 CFR 122.21(k)(5)(v))1PollutantPresence or Absence(check one)Reason Pollutant Believed Present in DischargeAvailable Quantitative Data(specify units)BelievedPresentBelievedAbsent20. 2,4-D (2,4-Dichlorophenoxyacetic acid)21. Diazinon22. Dicamba23. Dichlobenil24. Dichlone25. 2,2-Dichloropropionic acid26. Dichlorvos27. Diethyl amine28. Dimethyl amine29. Dintrobenzene30. Diquat31. Disulfoton32. Diuron33. Epichlorohydrin34. Ethion35. Ethylene diamine36. Ethylene dibromide37. Formaldehyde38. FurfuralEPA Form 3510-2D (Revised <INSERT DATE>)Page 28EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE E. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS (40 CFR 122.21(k)(5)(v))1PollutantPresence or Absence(check one)Reason Pollutant Believed Present in DischargeAvailable Quantitative Data(specify units)BelievedPresentBelievedAbsent39. Guthion40. Isoprene41. Isopropanolamine42. Kelthane43. Kepone44. Malathion45. Mercaptodimethur46. Methoxychlor47. Methyl mercaptan48. Methyl methacrylate49. Methyl parathion50. Mevinphos51. Mexacarbate52. Monoethyl amine53. Monomethyl amine54. Naled55. Napthenic acid56. Nitrotoluene57. ParathionEPA Form 3510-2D (Revised <INSERT DATE>)Page 29EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE E. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS (40 CFR 122.21(k)(5)(v))1PollutantPresence or Absence(check one)Reason Pollutant Believed Present in DischargeAvailable Quantitative Data(specify units)BelievedPresentBelievedAbsent58. Phenolsulfonate59. Phosgene60. Propargite61. Propylene oxide62. Pyrethrins63. Quinoline64. Resorcinol65. Strontium66. Strychnine67. Styrene68.2,4,5-T (2,4,5-Trichlorophenoxyaceticacid)69. TDE (Tetrachlorodiphenyl ethane)70.2,4,5-TP [2-(2,4,5-Trichlorophenoxy)propanoic acid]71. Trichlorofon72. Triethanolamine73. Triethylamine74. Trimethylamine75. Uranium76. VanadiumEPA Form 3510-2D (Revised <INSERT DATE>)Page 30EPA Identification Number Facility NameOutfall NumberForm ApprovedOMB No. <INSERT NO.>Form Expires <INSERT DATE>ContainsNonbindingRecommendationsDraftApplicationForms–NotforImplementationTABLE E. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS (40 CFR 122.21(k)(5)(v))1PollutantPresence or Absence(check one)Reason Pollutant Believed Present in DischargeAvailable Quantitative Data(specify units)BelievedPresentBelievedAbsent77. Vinyl acetate78. Xylene79. Xylenol80. Zirconium1Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR Part 136for the analysis of pollutants or pollutant parameters orrequired under 40 CFR chapter I, subchapter N orO. See Instructions and 40 CFR 122.21(e)(3).